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Walmart Pharmacy 10-7611
CAH141347-00 CARLINVILLE AREA HOSPITAL
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Covered Entity Details
Entity Name
CARLINVILLE AREA HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141347-00
Entity Address
20733 NORTH BROAD STREET
CARLINVILLE, IL 62626
Medicare Provider Number
141347
Participating Start Date
7/1/2017
Last Recertification Date
9/17/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
1/14/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brian Burnside, President/CEO
(217) 854-3141 Ext: 310
Contract Pharmacy Representative
Walmart
Nick Tallman, Sr. Director, Merchandise Operations – Pharmacy
(479) 371-0417
Signed By Date
1/14/2025
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